2015 ISAKOS Biennial Congress ePoster #133

Ankle Sprains, Not a Simple Injury, Avoiding Long Term Sequelae

Stephanie C. Petterson, MPT, PhD, Old Greenwich, CT UNITED STATES
Christopher Kinner, BA, Stamford, CT UNITED STATES
Allison Green, PhD, Stamford, CT UNITED STATES
Kevin D. Plancher, MD, MPH, New York, NY UNITED STATES

Orthopaedic Foundation and Plancher Orthopaedics & Sports Medicine, Greenwich and New York, CT and NY, USA

FDA Status Not Applicable

Summary: There is a high incidence of bone contusions with both medial and lateral ankle sprains, therefore, MRI is critical following an acute injury to accurately diagnosis the extent of the injury and prescribe proper treatment to decrease risk of long term, chronic injury.




Improper diagnosis and treatment of ankle injuries can prolong recovery, lead to recurrent injury, and have devastating effects on quality of life. Soft tissue and cartilage injuries can go undetected without MRI. The purpose of this study was to determine whether severity or laterality of ankle sprain correlates with the presence of bone contusions.


Patients with ankle pain for <3 months, clinical diagnosis of medial or lateral ankle pain/sprain, and an MRI read by a musculoskeletal-trained radiologist were eligible. Patients with ankle fractures or posterior ankle pain with no lateral or medial symptoms were excluded. Ankle sprain grade and the presence and location of bone contusions and associated injuries were recorded. Chi-square analysis and odds-ratios were computed




One-hundred patients (20 medial, 55 lateral, 7 medial and lateral) were eligible. Bone contusions were the most prevalent associated injury, occurring in 65% of patients. Presence of bone contusion was significantly related to laterality (chi-square=4.13, p=0.042) and severity of lateral (chi-square=51.57, p<0.00001) and medial ankle sprains (chi-square=10.54, p=0.005). Medial sprains were 1.18x more likely to have bone contusion compared to lateral sprain. Grade 1, 2, and 3 lateral ankle sprains were 1.4x, 1.3x, and 1.75x more likely to have bone contusions compared to no lateral sprain. Grade 1 or 2 medial ankle sprains were 1.73x and 1.57x more likely to have bone contusions compared to no medial ankle sprain.


Bone contusions are more likely with medial sprains and significantly correlated with ankle sprain severity. Bone contusions are more likely with Grade 3 lateral sprains but with medial sprains, bone contusions occur with lesser degree of sprain severity (e.g. Grade 1 and 2). MRI is critical in diagnosing bone contusions and other injuries and should be prescribed for all acute ankle sprains to make an accurate diagnosis and for appropriate treatment to decrease risk of long term chronic injury.